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4%2/2013 Catherine Hostetler - s'chpc Irz 1.pdfPa <br />y 4 rn P µ M1 <br />' ge 1 <br />12COAVp1k2don.pdf <br />Mtp://www.shosephCounWndiam=n/departments/51CHP/Coati <br />Application <br />.FOR - <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND do ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd , South Bend, IN 46601 <br />http:/Avww.stjoscphcountyindiwmconL/departinenumCHPfmdex.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@cost-joseph.in.us <br />■ <br />oMCEUSEONcts>r»woxerrnMn �xvrxrnr�coxrxm�cennmrncadox««�or�rcEusEoNcr <br />Date Reedved: A � -2 043 AppSatiou Namur: c�W,3 <br />Past Reviews: ❑ YES towef"wirete l ❑ NO <br />Staff Approval authorized by: <br />Titin. <br />Hhterle Preservation Commission Review Date: <br />❑ Loin Landmark -coral Historic District tx ad �(a 1r <br />❑ National Landmark ❑ National Register District(6wd (� <br />CertillesteofApp ro risteaon: <br />=led ❑ Tabled ❑ Seat To Committee r Kppproved and [need: ✓t -u! • "13 <br />t.! A <br />(Please Print) 4l / rJ _ Kl vw AyG & u � S6 <br />Address of Property for proposed work: v <br />— <br />(Street Nwnher-Simi Name --01) -Zlp Code) Q �} <br />Name of Property Owner(s): .l iitl Phone#: 6W" 0v 5- <br />Address of PropertyOwner(s): / , S6 4401 <br />(Street Narnber-Street Name -Uy Zip Code) /� n <br />Name of Contractor(s): I "I."l.�/l _ T�LQ�_ Phone k: 2:5,2 <br />-40'1'7 <br />Contract Company Name: /) I Z �%65'5 / ( f <br />Address of Contract Company: Z B �� G �f7t� Kul A), u rwf 'm 4 <br />CC (S&mt Nunrbe>`Strert Name -City -Zip Code) G <br />Current Use of Building: C7 %� `-'f 7(�� <br />(Single F /y-Multi-Famil)--Comm ial--Govemment-Industrial-Vacant--etc.) <br />Type of Building Construction: wvvcv ` LVd.L_ <br />(Wood Frame-Brick-Stone-Seel-Conerete-0ther) <br />Proposed Work: no -Kind [&Uodscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description otProposed work: i14 rtA lu.,-_ �� /A -41W_ or- kV9.� - - - - - • <br />f�,• <br />is <br />Owner/Contractor Rax M 7131_ ?-? / <br />(Stojjwi conrespoh only one designee) <br />X <br />1.1 of 3 Signature of Owner <br />and/or X <br />Signature of Contractor <br />T"&, <br />1 n I I if 2l-eAJR, 7I/ U y V 91 a&-,, <br />4/1/13 9:17 F <br />